Switch to concierge services enhances revenues

To think that Dennis J Egitto, MD, was worried that patients would leave if he used concierge services. Instead, the practice has grown

Dennis J. Egitto, MD, launched a hybrid concierge medicine program at his North Palm Beach, Florida, practice where he offers around-the-clock access through his personal cell phone and email, but says few concierge patients take advantage of the exclusive access.

General internist Dennis J. Egitto, MD, considers himself an old-fashioned doctor in some ways. He has a solo practice, has no nurses or physician assistants, and still performs rounds at the hospital.

In 2008, Egitto, who practices in North Palm Beach, Florida, considered switching to a concierge model, a practice structure in which he would end his health insurer contracts, cull his patient panel to 300 or 400, and charge the remaining patients directly via an annual fee for his services.

With more than 1,600 patients, however, Egitto was reluctant to discharge more than 1,000 patients just to make more money and relieve some of the paperwork and hassle of managed care. Around this time, he read about an alternative practice model where he could charge an annual concierge fee for a small portion of his patients—typically less than 100—for extra services, such as a longer, comprehensive annual physical and follow-up, and around-the-clock access, but he could continue to see his traditionally insured patients.

"I just didn't want to lose any patients," Egitto says. "That was my main concern."

He had nothing to worry about, because 84 of his patients signed up for the program, and no patients left his practice. This hybrid concierge program has helped Egitto boost his income by 15% and allows him to see 20 or fewer patients a day.

"This seemed to be a perfect opportunity to take a little time for a handful of people who would want this," Egitto says. "That was what I was surprised by, because I didn't know that they would want it, that they would want me to be a concierge doctor for them."

A NEW MODEL

In a traditional concierge practice model, the physician typically drops out of network for third-party payers and requires patients to pay an annual fee. The physician provides the patient a superbill if he or she chooses to submit visits to the patient's insurance company.

As many as 10,000 physicians nationwide have some sort of concierge service or retainer associated with their practices, estimates Thomas LaGrelius, MD, a family physician in Torrance, California, and chairman of the American Academy of Private Physicians, the medical society for concierge physicians. In 2000, only about 150 doctors ran any type of concierge model.

"Most [concierge physicians] are below the radar and want it that way, so they don't join groups that make them identifiable," says LaGrelius. "Recent estimates in the press of 700 to 2,000 are clearly way low."

At a Glance

Egitto had heard about traditional, full-fledged concierge practices launching in the wealthy Palm Beach area of Florida, which had a per capita income of $109,000 in 2000, according to the most recent U.S. Census report. The population of Egitto's practice, however, is not affluent, he says. Approximately one-third of his patients are on Medicare, and the rest are insured by one of five major health plans that serve his area.

Egitto was not interested in traditional concierge, he says, "because you have to cut off almost all your patients, and I didn't want to stiff people who had been with me for years."

He received a brochure in his mail from a company called Concierge Choice Physicians in Rockville Centre, New York. The company, which has 180 physician members, helps practices establish and manage concierge programs at traditional practices. (For insight about setting up a hybrid concierge practice without hiring a company, please see the sidebar "Hybrid concierge DIY".) After meeting with a company representative, Egitto says he was more confident about offering the service to his patients.

"It sounded like it would be more how it used to be," says the 60-year-old Egitto, who started practicing in Brooklyn, New York, in the 1970s. "I could slow down a bit, talk to patients, and get to know them better. I just felt like it was easier for everybody."